Decompressive craniectomy in traumatic brain injury: Transcranial Doppler sonography used as a guide

Abstract

BACKGROUND: Decompressive craniectomy (DC) is performed in the management of intracranial hyper-tension after traumatic brain injury (TBI). This study aims to investigate the effects of transcranial Dop-pler ultrasonography (TCD) measurements on the indication of decompressive surgery. METHODS: Sixteen TBI patients with a Glasgow Coma Score (GCS) <9 were included in this study. Intra-cranial pressure (ICP) monitoring and transcranial Doppler ultrasonography (TCD) measurements were recorded continuously. DC was performed according to the records of ICP and TCD. Glasgow Outcome Scale (GOS) scores were evaluated after three months. RESULTS: Mean age of the patients was 31.18 +/- 17.51; GCS ranged between three and 14 with a mean of 9.62 +/- 3.95. Mean GOS was 3.12 +/- 1.85. Craniectomy was performed in two patients (12.5%) and cra-niectomy and lobectomy together were performed in 14 (87.5%) of them. The decline in ICP (22.12 +/- 10.41, 22.62 +/- 7.35, 15.50 +/- 6.64) and pulsatility index (PI) (1.96 +/- 1.10, 1.64 +/- 0.75, 1.91 +/- 2.48) were strongly significant between days 3-5, and 1-5. The range of PI and Vmax values through five days did not present any significance. CONCLUSION: TCD, as a real-time monitor, may help for an early decision of surgical approach in the management of TBI patients.